Basic Information
| Provider Information | |||||||||
| NPI: | 1003494394 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRAVELING HEART THERAPY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1893 | ||||||||
| Address2: | |||||||||
| City: | MARYLAND HEIGHTS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630436893 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6363285212 | ||||||||
| FaxNumber: | 6363334510 | ||||||||
| Practice Location | |||||||||
| Address1: | 2200 W PORT PLAZA DR STE 326 | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631463214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6363285212 | ||||||||
| FaxNumber: | 6363334510 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2021 | ||||||||
| LastUpdateDate: | 06/24/2021 | ||||||||
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| AuthorizedOfficialLastName: | COX | ||||||||
| AuthorizedOfficialFirstName: | COURTNEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER, LPC | ||||||||
| AuthorizedOfficialTelephone: | 6363285212 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor |
No ID Information.